Measuring and Responding to the Texas Opioid Crisis

We are facing a crisis of opioid addiction and overdoses in the U.S. and in Texas. The Centers for Disease Control and Prevention (CDC) reports that the rate of drug overdose deaths involving opioids in the country increased from 2.1 per 100,000 people in 1999 to 8.8 per 100,000 people in 2014. Texas had a lower overdose death rate than the national average, but overdose deaths increased rapidly in Texas too, from 1.5 to 4.2 per 100,000 people in the same time period.

Despite Texas’ rank of 48 out of 50 in opioid overdose deaths nationally, four of the countries’ 25 worst cities for opioid abuse rates are in the state: Texarkana (#10), Amarillo (#13), Odessa (#15), and Longview (#17). It is important to note that the state does not currently have reliable data that tracks the number of people who die year-to-year because of a drug overdose in general, largely due to an inconsistent system of investigating and reporting causes of death. It is very likely the number of overdose deaths in the state is underreported.

One of the strongest indicators that Texas has not escaped the national opioid crisis is the number of women dying while pregnant or shortly after giving birth. The state’s Maternal Mortality and Morbidity Task Force has been conducting an in-depth investigation into the death records of women to try to understand the state’s high maternal death rate. The Task Force’s latest report, released on September 29, revealed new data showing that drug overdose was the leading cause of pregnancy-associated deaths (women who die two months to one year after giving birth) between 2012 and 2015.

The number of drug overdose deaths in postpartum women highlights the need for behavioral health services before, during and after pregnancy. The Task Force finding is an opportunity to focus on mental health and substance use disorder treatment services in the prevention of maternal death and the state’s population as a whole. The Task Force points to the Texas Health and Human Services Commission’s (HHSC’s) existing program aimed at preventing and treating opioid use in pregnant women and reducing the number of babies born with neonatal abstinence syndrome (NAS) as a key intervention.

The Texas Targeted Opioid Response Grant (TTOR)

This past May, Texas received $27.4 million in federal State Targeted Opioid Response grants issued to states across the country from the Substance Abuse and Mental Health Services Administration (SAMHSA) to combat opioid use disorders. The Texas Targeted Opioid Response grant (TTOR) aims to increase efforts in the prevention and treatment of substance use disorders, specifically prescription drug and illicit opioid dependence. The grant will be used for prevention, training, outreach, treatment and recovery support services over a two-year period. HHSC estimates the grant will directly impact 14,000 people across the state.

TTOR funds will focus on populations at risk for opioid use disorders: people who live in major metropolitan areas, women who are pregnant and postpartum, and people who have a history of prescription opioid misuse. The grant will also target people who may be at an increased risk of developing an opioid use disorder, including people being treated for chronic pain, veterans, and people who live in rural areas with high rates of opioid use. HHSC plans to expand opioid prevention and treatment services through its existing providers and recruit new providers to expand the provider network, including Local Mental Health and Behavioral Health Authorities and new contracts with university partners.

To Keep in Mind

The extent of the opioid epidemic in Texas is currently difficult to accurately measure, but regardless of Texas’ precise ranking, it needs attention to ensure people are receiving the health care they need. Those in need of mental health and substance use disorder treatment services need access to long-term sustainable treatments and supports. Additionally, it is important to remember that substance use disorder needs to extend beyond opioid addiction, and to avoid making access to treatment for Texans experiencing addiction dependent on which drug they use.

Monica Villarreal joined the Center in 2016 as a Hogg Mental Health Policy Fellow. She has previously worked on advocacy for disability issues and has policy experience from working at Disability Rights Texas and the American institutes for Research. Villarreal is a native of Monterrey Mexico and moved to Austin in 2010 to attend school at the University of Texas at Austin where she received a bachelor’s degree in Government and Latin American Studies and a Master’s of Public Affairs from the LBJ School of Public Affairs.